analysis of the importance of the nhs within our society essay

8/10/2019 Analysis of the importance of the NHS within our Society ESSAY

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Sophie McArthur [email protected]

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Analysis of the importance of the NHS within our Society

Introduction

In the early 20thcentury not much had been done in order to improve the health of the

nation, except from improving sanitation in the Victorian era. After the Boer Wars in

18801881 and 18991902 (1) it came to light how poor the health was of the Britishtroops, this led to an interest in public health. In 1948 the National Health Service was

set up, it was one of the first of its kind in the world. In December 1948 a report was

released by Sir William Beveridge entitled Social Insurance and Allied Services, this was

the birth of the welfare system and the free health service for the public. (2)

The NHS was set up with 3 core principles:

that it meet the needs of everyone

that it be free at the point of delivery

that it be based on clinical need, not ability to pay (3)

The NHS has been a huge part of the English culture for more than 65 years. Despite its

varied positive and negative media attention support for the NHS as an institution has

always been strong. However public approval wavers for example when waiting lists get

too long. (4)And in 2012 only 3% of people felt that the system needed to be overhauled.

(5)

Over the past 65 years there have been a few reorganisations within the NHS one of the

most prominent ones being in 1974 when the conservative government set up health

authorities for individual areas of the country (6), this was one of the first attempts at

creating a more personalised health care service.

The Current Climate of the NHS

Over the last few years the NHS has been very prevalent in the media and a lot of bad

attention has came from the Mid-Staffordshire public health report that was published

in February 2013. The report highlighted the failings of the NHS and how there is a

culture emerging that is driven by the need to surpass targets rather than the need of

the patient. (7)In addition more cases of malpractice have come to light in recent

months, for example at Colchester hospital where patientsrecords were falsified in

order for them to appear to meet cancer waiting time targets. This has resulted in at

least 6,000 of the patients lives being put at risk because they did not receive cancer

treatments within the 62 day limit(8)

.

The failings among the NHS have led to the coalition government imposing a

reorginisation that came into practice in April 2013. This has been the largest

reorganisation since the launch of the NHS. The main features of this reorginisation

were to give local authorities a bigger role in the organisation of the healthcare services

in their area. As a result of this the 152 Primary Care Trusts have been abolished and

have now been replaced with more than 200 GP led Clinical Commissioning Groups that

have control of 62% of the NHS budget. The reorginisation has happened with the

intention that if GPs are given more control over NHS budgeting this will benefit thepublic more because the role of the GP is to work within the community (9).


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(9)

Part-Privatisation of the NHS

This reorganisation has sparked many criticisms as it appears that the government aretrying to sell off the NHS by privitising certain sectors. This new movement goesagainst the entire ethos of the NHS mainly that it should be free at the point of delivery(10).The public have now became accustomed to the fact that services like opticians,

dentists and pharmacies are privatised and it is predicted that by 2016 only 16% of the

NHS will be managed within the public sector(11). This has caused outrage for many

people, from the general public to the Chief Executive of the London university

hospitals, Sir Robert Naylor. He has been quoted saying Patients must travel further.Failing hospitals will have to close. But that's how you save lives.(12) Furthermore a

quote from Collin Humphries, an Anatomical pathology technician at Walsall Manor

Hospital depicts another rather sarcastic take on government policy. The thing that Ivenoticed over the last 24 years is governments just constantly trying to meddle. A lot of

time is wasted reinventing the wheel.(13)Without a doubt this is a controversial thing to

say, the NHS has been a positive development in society and now many people believe

that the government are effectively destroying it. This quote is flawed in a way because

it is arguable how fit for purpose the NHS actually is. It doesnt need to be reinvented-more reorganised and the money needs to be redistributed more fairly.

The Results of the part-privatisation and the NHA party

The National Health Action party was launched in 2012 by a consultant cancer specialist

called Dr Clive Peedell and the retired Physician and former MP Dr Richard Taylor. The

party is made up of doctors and nurses who have experienced first-hand the effects ofthe reorganisation of the NHS (14). The party was set up in order to fight for the original

values of the NHS i.e. for it to be free at the point of need and publicly provided to

maintain a fair and equitable service across the country (15). The NHA party is the onlygovernment party that is fighting against the privatisation that is costing the tax paper

4 billion (16). The party believe that the changes that happened in April 2013 werentjustified as they werent voted for by the public and they do not benefit the public as the

part-privatisation has caused the NHS to be more wasteful and this in turn makes it

increasingly unsustainable. The NHA have created an action plan illustrating what they

plan to do, this includes reversing budget cuts and making sure that the levels of staff

are sufficiently high to make sure that all patients are safe and also they will exempt the

NHS from the EU/US free trade agreement to make sure that it wontbe privatised(17).


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Data Analysis from both Primary and Secondary Sources

Analysis of the primary data

To collect the data for my primary research I used a website that has been provided by

the BBC in a bid to make hospital data more transparent, specific postcodes can be

searched for anywhere in England and it will give the data for that hospital trust, for

example waiting times and attendance at A&E(18). I conducted my research by using a

random number generator to pick each hospital from a list of counties all over England

(19). This will reflect the country better as a whole as there are many subsections for

London and this is where many people live, hence there are many hospitals there. Once

I had picked the hospital I obtained its postcode and imputed this into the A&E weekly

tracker. I made sure that I picked all of the hospitals within the same time frame to

reduce the subjectivity that would happen from week to week. I have specifically picked

16 sets of data in order to carry out statistical tests.

The figure below shows the distribution of the hospitals that I have chosen to obtain the

data from.(20)


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DataTablesforPrim

aryResearch


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Statistical Analysis of the Data

In order to find out if there was a correlation between the data I found I have carried

out some statistical tests. For all of the data I have worked out the product moment

correlation coefficient, this tells you if there is a correlation between the two sets of

data. For example if r=1 then there is a strong positive correlation and if r=-1 there is astrong negative correlation.

Underneath is an example of the calculation that I carried out when I was comparing

the percentage of patients seen within four hours and the overall attendance at A&E.

(21)

xy=3429031.1x=1460.3

y=37381

x2=133527.9

y2=111026173

n=16

=2336.3

x=91.3

The regression value is 0.226 (3sf), hence there is a small positive correlation; this

correlation is not significant enough to use. For a regression value to be showing a

significant correlation the value would need to be either over +0.7 (moderately strong

positive) or lower than -0.7 (moderately strong negative). From this very weak

correlation the conclusion that can be made is that there is little variation in hospital

waiting times against the amount of the people who have attended A&E. This is

reassuring as it means that there is equality in the waiting times in these hospitals

based on that criterion. In addition, from the data it would appear that there is a

correlation between the number of people who have to wait more than four hours to be

seen and the trolley wait between 4 and 12 hours. The regression coefficient value for

this data is 0.748 (3sf) which would show a moderately strong positive correlation. Thissuggests that if the hospital has long waiting times for patients to be seen then there is

3429031.1 (1460.3)(37381)16133527.9 (1460.3)16 (111026173

(37381)16 )


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also a long trolley wait, i.e. if it is failing in one aspect of waiting times it is also likely to

be failing in the other. There is a large variation in the trolley waiting times because in

four hospitals there has been 0 people waiting for a trolley between 4 and 12 hours and

in other hospitals there has been as many as 169 people waiting. I think that this data

however is inconclusive because the title for the data is Trolley wait between 4 and 12hours there is no data for people who possibly had to wait longer than 12 hours, also

there is no data for the people who had to wait under 4 hours, for example the hospitals

who have recorded 0 could have kept all of their patients waiting for slightly under 4

hours in order to appear on target. Also it is unclear from which point this clock begins

and, as it has been illustrated in the media these figures can be very easily manipulated

in order to appear to comply with the targets.

A Graph To Show the Variation of the Percentage of Patients seen within 4 hours at a

Distribution of Hospitals in England

The mean for the percentage of patients seen within 4 hours featured in the graph

above is 91.3% and the standard deviation value is 4.07 this shows that there is a

significant variation in the data. This is a significant difference that shows that

depending on which hospital a patient goes to there will be a variation in waiting times.

The graph above shows that this is unlikely to be due to the size of the A&E department

so it must be due to a combination of different factors (from previous analysis this cant

0

10

20

30

40

50

60

70

80

90

100

PercentageofPatientsthatwereseen

within4

hours/%

A Random Sample of

Hospitals in England


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be due to the number of patients). The percentage of people waiting for more than 4

hours to be seen ranges from 80.2% at Kettering General Hospital to 96.8% at East

Surrey Hospital. A staggering 87.5% of the hospitals in the study have not met the

government targets that say that 95% of people should be seen within the 4 hour

timeframe(22)

, that is only 2 out of the 16 hospitals in the study are actually on target,these hospitals are Saint James University Hospital (who have just made it with 95.1%)

and East Surrey Hospital (96.8%). This suggests that either the targets that are set by

the government are unattainable and need to be lowered or that the hospitals need a

lot more help in the form of extra staff and better ways of managing the people who

come into A&E.

Transparency of the Data collected

The data that I have collected has been made available to the public in a bid to make the

data more transparent however as is obvious from my research the data is not

transparent at all and is still indeed very subjective. For example the headings that the

data come under are not very informative and because of how vague they are it is very

easy to manipulate them. The variation in data for planned operations cancelled is huge

and it would seem that the hospitals have been recording their data in different ways as

the range of data is from 0 up to 71. It is very easy to manipulate this data, an example

of this being that hospitals do not cancel operations as this wouldincrease the figures

however they delay the operations instead which then doesnt have to appear in the

data. This is dangerous as the waiting lists for operations become longer and this can

lead to complications for patients who do not receive their operations at the correct

time.

Another example of the manipulation of figures is in the Colchester Hospital scandal

that has been mentioned previously where cancer records were falsified in order to

appear to comply with cancer treatment waiting time targets. In order for the NHS to

improve, the data has to become clearer as the public have a right to know how their

local trust is performing. The NHS call to action has suggested that data should be

available to all and from July 2013 the NHS choices website has shown

recommendations and comments about peoples experiences in hospitals in England(23).

Analysis of Secondary DataOver the past few decades public health has increased significantly, this means that we

now have an ageing population. Although this is generally good news it also means that

a larger strain is being put on the NHS. Many studies have shown that elderly patients

account for the largest NHS health expenditure and one particular study has revealed

that people over the age of 75 can cost the NHS up to 13 times greater than the rest of

the population(24). Underneath is a graph that shows the expenditure over the last 12

months of peoples lives.


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(25)

What does the graph show?

The graph shows that the cost of hospital care and social care changes dramatically withage. From the age of 45-75 the cost of hospital care remains very much the same with a

few fluctuations, after this it decreases dramatically. Up until the age of 70 the cost of

social care remains fairly low and after 70 it increases exponentially until death. From

the age of 45-100 the cost of combined hospital and social care increases steadily

because the cost of social care is so low in people under 75 the combined cost line

almost mirrors the hospital line with a slight fluctuation at 60 where the combined care

costs increase by 1084 this could be due to people retiring at around 60. The graph

clearly shows how important social care is in an elderly persons life. Due to the recent

cuts the social care budget has been decreased by 2.7 billion (26)this has led to many

elderly people not receiving as much support from their local authority for the costs of

living in residential homes or nursing homes. As a result of this they have to go into

hospital as they cannot receive basic care and help. Taking away this funding is

catastrophic because in the long run it will only end up costing the tax payer more

money as hospital care is a lot more expensive than general social care.

How reliable is the graph?

The data that this graph has been based upon was data that was recorded for 16,479

individuals who died in 2007 from three different primary care trusts; the study was

carried out over a 12 month period. I think that this investigation was fairly reliable asthe sample size was large and it was carried out over a relatively long period of time.


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However it is important to realise that this study was from a sample of people only from

3 Primary Care Trusts so it cant possibly reflect the whole of the population in England

because it doesnt cover a big enough demographic area. In addition although 12

months is a relatively long period of time, due to this the study only incorporated one

set of people, to make the study more reliable it needs to be carried out for 12 monthsbut it needs to be repeated many times with people from health authorities all over the

Country. Some health authorities may be better or worse than others i.e. there may be

inequality in the treatment of specific illnesses that the people in the study may have

had. Also because there is no raw data available it is hard to see how the information

has been manipulated when plotted on this graph, there may have been anomalies that

have been omitted from the mean in order not to appear to distort the graph. In

addition there is no indication of how the mean was worked out it could have been a

mean average, a mode, or a median of cost, this is hard to tell as also the graph is

missing standard deviation bars which could have shown huge overlaps in data hence

there wouldnt be any significant difference in data.

Why is this study important?

This study is very important as it shows what money is being spent where and it is part

of the Nuffield Foundations movement in order to make data more transparent. Now

that the data is available for these hospitals the Nuffield Trust is planning on repeating

the investigation in order to obtain more data from a range of health authorities. Now

that the costs have been identified it is important for the NHS and government to work

out how to reduce them in order to manage the NHS budget more efficiently because

from the age of 45 to the age of 85 the cost of combined hospital and social careincreases by 35%(27).


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Conclusions and Analysis of How the NHS Can Become More Sustainable for Future

Generations

There are three main factors that are causing the NHS to become unsustainable:

-Ageing society

-Rise of people living with long term conditions

-Increasing expectations

Due to the success of public health in England people are living longer, this is beginning to

put an increased strain on the NHS as nearly two thirds of people who are admitted to

hospital are over 65 years old(28)

. This means that they take up a lot of the healthcare

budget as they are also more likely to be readmitted. Recently the social care budget has

been cut by 20% this has pushed the NHS even more as now in many wards the beds are

very close to 100% occupancy most of the time. As is displayed in the previous data it is

clear that when the social care budgets are cut the people who are worst affected are the

elderly as they rely more and more on social care as they come to the end of their lives. The

decrease in social care funds has been due to the austerity of the coalition government and

these cuts have actually cost the tax payer more money as now there are more people being

admitted to hospital which is a lot more expensive than community based social care. In

addition there are now more people living with one or more long term conditions, for

example heart disease and mental health problems, these people also need social care in

order to keep them out of hospital, however the budget cuts have ensured that care within

the home is virtually impossible, this is costing the NHS dearly as is illustrated in the data

below.

(29)

As a society we have become accustomed to having an NHS and some people would say

that we have taken it for granted: it is estimated that people who miss appointments costthe NHS about 700 million a year

(30). Furthermore we now live in a blame culture where


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everyone has to be accountable for everything that happens. The NHS spends 700 on

insurance for each birth in England this is because if there is a problem with a birth that

leads to medical problems for the rest of a childs life there is no funding to help the parents

look after the child. The parents are then forced to sue the hospital in order to be able to

pay for the care that the child will need throughout its lifetime. This means that a lot ofmoney is wasted on expensive legal fees and this seems ludicrous as this whole process

could easily be prevented by having adequate social care in place at the beginning(31)

.

As technology develops patients are receiving more sophisticated treatment this costs the

NHS more money and it is difficult to decide which treatments are more worthy of the

budget. People expect to have access to every new treatment which often come at great

expense, also patients want more flexibility in their treatment, they want to have to travel

less to receive treatment at times that are more convenient to them. There are other

lifestyle changes within our society that are also putting a huge strain on the NHS one of themost significant being the rise of obesity in recent years. It is estimated that by 2035 46% of

men and 40% of women will be obese; this creates many new problems(32)

. It is known that

with obesity comes many complications and there are strong links with obesity and type 2

diabetes and heart disease. Treating these long term conditions is very expensive and also

recently there has been an increase in people relying on the NHS for weight loss operations.

Gastric bypasses are available for people who meet certain criteria; this procedure would

have been unheard of 50 years ago. With weight loss comes excess skin, at the moment it is

uncommon for the NHS to fund the removal of excess baggy skin, however as obesity

becomes more prevalent this could be another costly procedure that will take up aproportion of the ever tightening budget.

(33)

The trend that this graph shows is that there is an increasing gap between the projected

resource for the country and what the projected costs are predicted to be. Unlike many

things the NHS budget didnt decrease with the recession however it has not increased


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either. The graph shows a slight increase in the projected resource due to inflation. By the

years 2020-2021 it is predicted that there will be a 30 billion deficit, in order to reduce this

the efficiency of the NHS needs to be improved. It has been said that in order to solve this

problem we could have a temporary increase in tax in order to get the NHS back on its feet,

however I am sure that this isnt favourable for many of the public. Moreover there havebeen suggestions of wage freezes for staff in the NHS. Again this is unfavourable as many

people would argue that it is unfair for the people who serve the public in well-respected

roles to forfeit their wages, whilst other in jobs they receive a much higher wage for doing

something that isnt as prestigious. Midwives take enormous risks, they bear huge

responsibility and yet they get paid a pittance. I dont know what risk a banker takes, but I

think I bear more responsibility than a banker would ever understand.Janet Fyle a midwife

in London(34)

.

What is the best plan of action for the future NHS?Without a doubt the NHS needs to change in order for it to still be running in future years,

there are mixed opinions about the best way to do this. It is clear that data must be more

transparent and available to the public as they have a right to have a control over their

health. This movement has been slowly progressing however there is still a long way to go.

Hospital trusts need to become more honest as one watchdog has found that treatment

statistics are often inconsistent and unreliable, with waiting times shortened in a fifth of

cases(35)

this makes people lose confidence in their health service and a lot of work needs

to be done to reverse its sullied reputation. Making data more transparent allows local

health authorities to decide on what treatment is best for a particular area and to make surethat they receive accurate funding for this; these measures are underway and will do well in

making care more tailor-made to suit the patient.

Some people believe that having healthcare that is free at the point of use is a drain on the

countrys wealth however, this need not be the case. The health service needs to be looked

upon as an investment, for example the economic cost of sick days on average costs the tax

payer 100 billion each year whereas health services only cost 60billion this saves nearly

half of the tax payers money(36)

. Furthermore the NHS is a huge consumer which funds

many business sectors such as pharmaceuticals and the biomedical research industry which

as a country we are now world leaders in. As technology improves it doesnt need to be an

economic hindrance as it can be a huge benefit to society as once the investment has been

made the benefits are huge.

I think that in order to make care more personalised it would be a good idea to make more

resources available online and on mobile phones. The public should be allowed to book

their appointments online and they should be able to have email consultations with doctors,

this has been tried and tested in countries like America and has been deemed very

successful. At the moment we have telephone appointments with GPs where they can

prescribe treatments to their patients over the phone, this saves a lot of time for both the


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doctor and the patient. Also there are new technologies now available for example e-

Intensive Care this has been trialed at a London hospital and provides another pair of eyes

for the hospital staff by using highly sensitive cameras and other instruments that record

the patients vital signs which means that the ward staff have more time to see other

patients(37)

.

As I have highlighted throughout this project prevention is better than cure, in order for the

health service to enforce these values there needs to be more screening programs set up

encouraging people to have a health check as regularly as they would go to the dentist. The

following data was obtained from research about breast cancer screening, the incidence of

breast cancer was severely reduced for the women who had had a previous screening.

There are also other data that support this claim that has been published on the well trusted

BMJ website.

(38)

Over the last few years we have seen an array of campaigns including stopping smoking and

healthy eating. In my opinion these campaigns are paramount in improving public health as

they reach many people in the country. Although it costs money to run these services the

benefit to public health is huge as it reduces hospital admissions and incidences of a variety

of chronic conditions. As mentioned previously the cost to the NHS for managing patients

with multiple illnesses is very expensive, a better way to manage patients is needed. This

could involve the use of life coaches that will educate people on how to look after

themselves and how to manage their conditions without having to be in the hospital
http://www.bmj.com/highwire/filestream/623820/field_highwire_fragment_image_l/0/F3.medium.gif


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environment. People want to be able to have more freedom in their care; this involves being

treated at home. The budgets for district nurses have been severely cut in recent years this

means that people have to come into hospital for help. We need to increase the social care

budget in order to decrease the spending within hospitals; going into hospital needs to

return to being a last port of call.

A very common occurrence within the elderly is that they end up in geriatric wards as there

is nowhere else for them to go where they will receive adequate care. Recent figures show

that in the last five years there has been a 93% increase in the amount of elderly people

(over 90 years old) attending A&E(39)

. There needs to be more funding for hospices in order

to get people out of hospitals and get them the more personalised care that they need.

It is very important that hospitals and the government embrace the changes within the NHS

and not ignore them; this could mean that there is a change in leadership within the

government and hospitals like we have already seen in the clinical commissioning groups

that have been set up around the country. We need to remember that the NHS needs to

treat the individual patient not the condition and in order to do this its about changing the

physiology of the NHS, not its anatomy(40)

.


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(1)http://en.wikipedia.org/wiki/Boer_Warspage 37 of public health policy

(2)XI page 11http://news.bbc.co.uk/1/shared/bsp/hi/pdfs/19_07_05_beveridge.pdf

(3)http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx

(4, 5)God Bless the NHS page 7&11

(6)God Bless the NHS page 10(7)

http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20sum

mary.pdfpage3

(8)http://www.theguardian.com/society/2013/nov/09/colchester-hospital-falsified-

cancer-records(9)http://www.bbc.co.uk/news/health-19674838(10)http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx

(11)http://www.theguardian.com/society/2011/apr/12/private-sector-involvement-

nhs(12)http://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-

voices-interactive(13)http://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-

voices-interactive(14,15,16,17)http://www.nationalhealthaction.org.uk/wp-

content/uploads/2013/07/NHA-Party-10-point-plan.pdf(18)http://www.bbc.co.uk/news/health-

25055444?postcode=NN16&nearest_hospital=default(19)

http://www.random.org/lists/(20)https://mapsengine.google.com/map/edit?mid=zo5vRO3MQ3Ew.krwrknLq_Gbc(21)http://filestore.aqa.org.uk/subjects/FORMULAE.PDF(22)http://www.theguardian.com/society/2013/apr/02/nhs-four-hour-targets-aande(23)The NHS Belongs to the people page 19(24)The NHS Belongs to the people page 12(26)http://www.telegraph.co.uk/health/elderhealth/10042070/Care-system-now-

unsustainable-after-3bn-cuts-social-services-chiefs-warn.html(25)(27)http://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-

last-year-life(28)

Call to Action page 12(29)

The guardian newspaper(30)

http://www.bbc.co.uk/news/health-17298612(31)

http://www.bbc.co.uk/news/health-17298612(32)

Call to Action Page 14(33)

Call to Action Page 16(34)

http://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-

interactive(35)

http://news.sky.com/story/1199546/nhs-waiting-times-unreliable-stats-hide-delays(36)

Call to Action Page 20
http://en.wikipedia.org/wiki/Boer_Warshttp://en.wikipedia.org/wiki/Boer_Warshttp://news.bbc.co.uk/1/shared/bsp/hi/pdfs/19_07_05_beveridge.pdfhttp://news.bbc.co.uk/1/shared/bsp/hi/pdfs/19_07_05_beveridge.pdfhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdfhttp://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdfhttp://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdfhttp://www.theguardian.com/society/2013/nov/09/colchester-hospital-falsified-cancer-recordshttp://www.theguardian.com/society/2013/nov/09/colchester-hospital-falsified-cancer-recordshttp://www.theguardian.com/society/2013/nov/09/colchester-hospital-falsified-cancer-recordshttp://www.bbc.co.uk/news/health-19674838http://www.bbc.co.uk/news/health-19674838http://www.bbc.co.uk/news/health-19674838http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.theguardian.com/society/2011/apr/12/private-sector-involvement-nhshttp://www.theguardian.com/society/2011/apr/12/private-sector-involvement-nhshttp://www.theguardian.com/society/2011/apr/12/private-sector-involvement-nhshttp://www.theguardian.com/society/2011/apr/12/private-sector-involvement-nhshttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.nationalhealthaction.org.uk/wp-content/uploads/2013/07/NHA-Party-10-point-plan.pdfhttp://www.nationalhealthaction.org.uk/wp-content/uploads/2013/07/NHA-Party-10-point-plan.pdfhttp://www.nationalhealthaction.org.uk/wp-content/uploads/2013/07/NHA-Party-10-point-plan.pdfhttp://www.nationalhealthaction.org.uk/wp-content/uploads/2013/07/NHA-Party-10-point-plan.pdfhttp://www.bbc.co.uk/news/health-25055444?postcode=NN16&nearest_hospital=defaulthttp://www.bbc.co.uk/news/health-25055444?postcode=NN16&nearest_hospital=defaulthttp://www.bbc.co.uk/news/health-25055444?postcode=NN16&nearest_hospital=defaulthttp://www.bbc.co.uk/news/health-25055444?postcode=NN16&nearest_hospital=defaulthttp://www.random.org/lists/http://www.random.org/lists/http://www.random.org/lists/https://mapsengine.google.com/map/edit?mid=zo5vRO3MQ3Ew.krwrknLq_Gbchttps://mapsengine.google.com/map/edit?mid=zo5vRO3MQ3Ew.krwrknLq_Gbchttp://filestore.aqa.org.uk/subjects/FORMULAE.PDFhttp://filestore.aqa.org.uk/subjects/FORMULAE.PDFhttp://www.theguardian.com/society/2013/apr/02/nhs-four-hour-targets-aandehttp://www.theguardian.com/society/2013/apr/02/nhs-four-hour-targets-aandehttp://www.theguardian.com/society/2013/apr/02/nhs-four-hour-targets-aandehttp://www.telegraph.co.uk/health/elderhealth/10042070/Care-system-now-unsustainable-after-3bn-cuts-social-services-chiefs-warn.htmlhttp://www.telegraph.co.uk/health/elderhealth/10042070/Care-system-now-unsustainable-after-3bn-cuts-social-services-chiefs-warn.htmlhttp://www.telegraph.co.uk/health/elderhealth/10042070/Care-system-now-unsustainable-after-3bn-cuts-social-services-chiefs-warn.htmlhttp://www.telegraph.co.uk/health/elderhealth/10042070/Care-system-now-unsustainable-after-3bn-cuts-social-services-chiefs-warn.htmlhttp://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-last-year-lifehttp://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-last-year-lifehttp://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-last-year-lifehttp://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-last-year-lifehttp://www.bbc.co.uk/news/health-17298612http://www.bbc.co.uk/news/health-17298612http://www.bbc.co.uk/news/health-17298612http://www.bbc.co.uk/news/health-17298612http://www.bbc.co.uk/news/health-17298612http://www.bbc.co.uk/news/health-17298612http://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://news.sky.com/story/1199546/nhs-waiting-times-unreliable-stats-hide-delayshttp://news.sky.com/story/1199546/nhs-waiting-times-unreliable-stats-hide-delayshttp://news.sky.com/story/1199546/nhs-waiting-times-unreliable-stats-hide-delayshttp://news.sky.com/story/1199546/nhs-waiting-times-unreliable-stats-hide-delayshttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.bbc.co.uk/news/health-17298612http://www.bbc.co.uk/news/health-17298612http://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-last-year-lifehttp://www.nuffieldtrust.org.uk/data-and-charts/average-care-costs-age-band-last-year-lifehttp://www.telegraph.co.uk/health/elderhealth/10042070/Care-system-now-unsustainable-after-3bn-cuts-social-services-chiefs-warn.htmlhttp://www.telegraph.co.uk/health/elderhealth/10042070/Care-system-now-unsustainable-after-3bn-cuts-social-services-chiefs-warn.htmlhttp://www.theguardian.com/society/2013/apr/02/nhs-four-hour-targets-aandehttp://filestore.aqa.org.uk/subjects/FORMULAE.PDFhttps://mapsengine.google.com/map/edit?mid=zo5vRO3MQ3Ew.krwrknLq_Gbchttp://www.random.org/lists/http://www.bbc.co.uk/news/health-25055444?postcode=NN16&nearest_hospital=defaulthttp://www.bbc.co.uk/news/health-25055444?postcode=NN16&nearest_hospital=defaulthttp://www.nationalhealthaction.org.uk/wp-content/uploads/2013/07/NHA-Party-10-point-plan.pdfhttp://www.nationalhealthaction.org.uk/wp-content/uploads/2013/07/NHA-Party-10-point-plan.pdfhttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/interactive/2012/mar/15/nhs-reforms-100-voices-interactivehttp://www.theguardian.com/society/2011/apr/12/private-sector-involvement-nhshttp://www.theguardian.com/society/2011/apr/12/private-sector-involvement-nhshttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://www.bbc.co.uk/news/health-19674838http://www.theguardian.com/society/2013/nov/09/colchester-hospital-falsified-cancer-recordshttp://www.theguardian.com/society/2013/nov/09/colchester-hospital-falsified-cancer-recordshttp://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdfhttp://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdfhttp://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspxhttp://news.bbc.co.uk/1/shared/bsp/hi/pdfs/19_07_05_beveridge.pdfhttp://en.wikipedia.org/wiki/Boer_Wars


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(37)Call to Action Page 19

(38)http://www.bmj.com/content/346/bmj.e8441?view=long&pmid=23299842(39)

http://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-

into-AandE-as-faith-lost-in-care-outside-hospitals.html(40)

Call to Action Page 4
http://www.bmj.com/content/346/bmj.e8441?view=long&pmid=23299842http://www.bmj.com/content/346/bmj.e8441?view=long&pmid=23299842http://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-into-AandE-as-faith-lost-in-care-outside-hospitals.htmlhttp://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-into-AandE-as-faith-lost-in-care-outside-hospitals.htmlhttp://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-into-AandE-as-faith-lost-in-care-outside-hospitals.htmlhttp://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-into-AandE-as-faith-lost-in-care-outside-hospitals.htmlhttp://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-into-AandE-as-faith-lost-in-care-outside-hospitals.htmlhttp://www.telegraph.co.uk/health/healthnews/10603413/Scandal-of-elderly-forced-into-AandE-as-faith-lost-in-care-outside-hospitals.htmlhttp://www.bmj.com/content/346/bmj.e8441?view=long&pmid=23299842

analysis of the importance of the nhs within our society essay

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